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Background DFR provides prehospital medical care to the residents of and the visitors to the City of Dallas Provision of this care potentially exposes DFR personnel to infectious diseases Good hand hygiene, and the proper selection, use and disposal of PPE are critical to prevent the spread of disease Oct

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Hand Hygiene: Soap & Water Use soap and warm, running water Keep fingers pointing down Rub hands vigorously for 20 seconds Wash all surfaces, including: Backs of hands Wrists Between fingers Tips of fingers Thumbs Under fingernails Dry vigorously with paper or clean cloth towel Turn off faucet with towel and open door with towel Oct

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Hand Hygiene: Sanitizer If hands are visibly contaminated, soap and water must be used first If hands are not visibly contaminated, or if soap and water are not available, use alcohol-based hand rub (gel, foam or wipes) Apply a generous amount of hand rub gel/foam to the palm of one hand, or use an alcohol- based hand rub wipe Rub hands together, covering all surfaces of hands and fingers until hand rub is absorbed Oct

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Airborne Precautions Small particles created by coughing, sneezing, suctioning, intubation or even talking Disease examples: TB, measles, chickenpox, disseminated Herpes zoster, smallpox Any patient known or suspected to be infected with an organism spread through the air, or for a patient “found down” with unknown history Oct

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Doffing (Removal) = Critical Process PPE must be removed in the proper sequence & with extreme care/caution, to prevent inadvertent exposure Basic Principle: Touch ONLY “clean to clean” and “dirty to dirty” Perform hand hygiene and replace gloves if hands become contaminated during removal, AND immediately after PPE removal PPE must be removed immediately after patient care is transferred to hospital staff Oct

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“Buddy System” A trained observer shall monitor the doffing procedure Can be used during donning, as well “Buddy” (in PPE) watches to prevent compromises or other procedural breaches Any compromise/breach must be reported to your EMS Field Supervisor immediately Oct

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Doffing: Overall Sequence 2 Members in Full PPE (including double gloves) 1 st member serves as “Buddy” for 2 nd member during doffing 2 nd member then dons fresh Standard Precautions and serves as “Buddy” for 1 st member during doffing 1 st member then dons clean gloves and serves as “Buddy” for 2 nd member during doffing Both members shall use meticulous hand hygiene after all PPE is removed NOTE: Proceed slowly and carefully to avoid breaches! NOTE: Gloves shall be removed, hand hygiene performed and fresh gloves donned at any point in the procedure, if needed, because of inadvertent contamination Oct

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Doffing Sequence Details Buddy sprays member with Lysol (especially legs and feet) Boot Covers: Touch ONLY outside, remove  Biohazard disposal, one at a time, as each is removed Do NOT contaminate by crossing legs Lean against wall or sit in chair, if needed Outer Gloves: Do not contaminate inner gloves, remove  Biohazard disposal Gown and Inner Gloves: Buddy unfastens from rear, then wearer rolls away from body, down to wrists, rolls into small bundle and removes without contaminating skin  Biohazard disposal HAND HYGIENE: Allow hand gel to be fully absorbed 30 Oct 2014

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Doffing Sequence (cont’d.) Don TWO pairs of clean gloves Bonnet: With ONE hand, grasp as far to the rear as possible and pull away from head and face  Biohazard disposal Goggles: With OTHER hand, grasp as far to the rear as possible and pull away from face  Biohazard disposal Outer Gloves: Remove without contaminating inner gloves or skin  Biohazard disposal Respirator/Mask: Grasp from as far to the rear as possible and pull away from face while actively exhaling  Biohazard disposal Oct

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Doffing Sequence (cont’d.) After 2 nd Member has removed all PPE and performed Hand Hygiene, (s)he dons a final pair of clean gloves and serves as a “Buddy” one final time, to assist the 1 st Member with doffing of the Hospital Standard Precautions PPE Both Members wash hands and all at-risk skin surfaces with soap and water, then perform thorough Hand Hygiene 33 Oct 2014

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Disposal of Contaminated PPE Once the contaminated PPE is placed in the Biohazard bag and the bag is triple-sealed: At a hospital, follow directions of facility staff If the Biohazard bag must be returned to a DFR station, deposit the bag in the contaminated material box for processing through Waste Management Oct

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Procedure Breach or Contamination In the event of contact with patient blood, body fluids, secretions or excretions during patient care: Stop work as soon as possible Wash the affected area thoroughly with soap and water Report the exposure as soon as possible to your EMS Field Supervisor for follow-up In the event of inadvertent contamination during doffing: Stop the doffing sequence immediately Wash the affected area thoroughly with soap and water, or with alcohol-based gel or foam Report the exposure as soon as possible to your EMS Field Supervisor for follow-up 35 Oct 2014

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Summary Hand hygiene is the single most important way to prevent infection spread Proper selection of appropriate PPE is vital Standard: ALL Patients Contact + Droplet: Sick Patients at risk for infectious diseases Airborne: Patients at risk for airborne-spread infection Doffing (removal) = greatest risk to Providers A “Buddy System” – especially during doffing – will reduce the risk of compromise/breach PPE must be disposed of properly after removal 36 Oct 2014

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If you have any questions… 1.Contact your EMS Field Supervisor, or 2.Contact M. Allison Green, RN Office Cell Oct